Emory University Hospital

Transcription

1 Emory University Hospital Community Health Needs Assessment July 2013

2 TABLE OF CONTENTS Message from Emory Healthcare and Emory University Hospital...1 Executive Summary...2 Overview of Emory Healthcare and Emory University Hospital...3 Community Health Needs Assessment Process...5 Service Area Demographics...8 General Health Rankings...13 Mortality...15 Morbidity...18 General Health Measures...20 Health Care Access...31 Community Stakeholder Interviews...35 Service Area Health Priorities...38 Appendix A. Data Sources & Information Gaps...39 Appendix B. Community Stakeholders Interviewed...42 Appendix C. World Health Organization Cause of Disease Classifications...46

3 CARE, COMPASSION, SERVICE In continuation of our commitment to the health and well-being of our community members, Emory Healthcare and Emory University Hospital are pleased to present this Community Health Needs Assessment. This report assesses the needs of the community served by Emory University Hospital using quantitative data and input from individuals representing the broad interest of the community. Using this report, Emory University Hospital identified three primary health needs of our community: Improve access to care in the community and collaborate with community partners to lessen the barriers to obtaining care Expand community awareness of healthy behaviors and available resources/care settings through education and community based programs Increase the focus on preventative care and disease management for chronic conditions in the community and hospital staff and improve the health of the community and hospital staff with a specific focus on diabetes, cardiovascular disease, stroke, and cancer Emory University Hospital developed strategies to outline how we plan to address the identified health needs of the community we serve. Through these strategies, Emory University Hospital strives to improve the overall health of our community, while delivering the best possible care to our patients. We consider it a privilege to care for the health needs of the people in our community. We want to continue making improvements and delivering the care you need, which is why this Community Health Needs Assessment will play an important role in directing the care we provide in the future. Thank you for entrusting us with your health and the health of your family. John T. Fox President & CEO, Emory Healthcare Robert J. Bachman CEO, Emory University Hospital & Emory University Orthopaedics & Spine Hospital July 2013 Page 1

4 EXECUTIVE SUMMARY Emory University Hospital (EUH) has proudly served the health care needs of our neighbors since EUH is a 579-bed adult, tertiary care facility. Emory University Orthopaedics & Spine Hospital, an extension of EUH s acute care services, is a 120-bed facility that provides medical and surgical care for orthopaedic and spine patients as well as general acute care for patients with nonsurgical needs. As a not-for-profit academic medical center, EUH is committed to providing the best care for our patients, educating health professionals and leaders for the future, pursuing discovery research, and serving our community. To understand the needs of the community we serve, EUH conducted a Community Health Needs Assessment using quantitative data (e.g., demographics data, mortality rates, morbidity data, disease prevalence rates, health care resource data, etc.) and input from stakeholders representing the broad interest of our community (e.g., individuals with special knowledge of public health, the needs of the underserved, low-income, and minority populations, the needs of populations with chronic diseases, etc.). Using the Community Health Needs Assessment, EUH identified the following priority health needs for our community: Improve access to care in the community and collaborate with community partners to lessen the barriers to obtaining care Expand community awareness of healthy behaviors and available resources/care settings through education and community based programs Increase the focus on preventative care and disease management for chronic conditions in the community and hospital staff and improve the health of the community and hospital staff with a specific focus on diabetes, cardiovascular disease, stroke, and cancer Implementation strategies were developed to outline how EUH plans to address the identified health needs of our community. Through these implementation strategies, EUH strives to improve the overall health of our community while delivering the best possible care to our patients. July 2013 Page 2

5 OVERVIEW OF EMORY HEALTHCARE AND EMORY UNIVERSITY HOSPITAL Emory Healthcare (EHC) is an integrated academic health care system committed to providing the best care for our patients, educating health professionals and leaders for the future, pursuing discovery research in all of its forms, including basic, clinical, and population-based research, and serving our community. As the clinical enterprise of the Robert W. Woodruff Health Sciences Center (WHSC) of Emory University, EHC is dedicated to the unifying core purpose, core values, and strategic direction of the WHSC. Core Purpose: To Serve Humanity by Improving Health through integration of education, discovery and health care Core Values: Excellence, Caring, Integrity Core values guide everyday behaviors. EHC lives by its core values in the following manner: Excellence: We are committed to continuous improvement in all that we do and strive to be a leader for others to emulate. We take pride in what we do as individuals and as part of a team. Caring: We demonstrate concern and compassion for our patients and their families, treating each person with dignity as we attend to the needs of the mind, body, and spirit. Integrity: We practice the highest ethical standards and honor our commitments. We take personal responsibility and ownership for our actions and demonstrate respect for our patients and their families, staff, and providers. We will steward our resources wisely to fulfill our mission. Vision: To be recognized as a leading academic health system, differentiated by discovery, innovation and compassionate, patient- and family-centered care. In addition to EHC, the WHSC includes Emory University School of Medicine, Nell Hodgson Woodruff School of Nursing, the Rollins School of Public Health, the Yerkes National Primate Research Center, and the Winship Cancer Institute of Emory University. EHC is the largest, most comprehensive health system in Georgia and includes Emory University Hospital, Emory University Hospital Midtown, Emory University Orthopaedics & Spine Hospital, Wesley Woods Center, The Emory Clinic, Emory Specialty Associates, three joint ventures: (1) Emory Johns Creek Hospital, Saint Joseph s Hospital, Saint Joseph s Medical Group, and Saint Joseph s Translational Research Institute (with Saint Joseph s Health System), (2) Emory Adventist Hospital (with Adventist Health System), and (3) Emory- Children s Center (with Children s Healthcare of Atlanta), and a management services July 2013 Page 3

6 agreement with Southern Regional Medical Center. EHC is passionately committed to providing our patients with the highest quality health care available in the world today. In 2012, EHC provided $72.1 million in charity care. Emory University Hospital Emory University Hospital (EUH) is a 579-bed adult, tertiary care facility. An extension of EUH s acute care services, Emory University Orthopaedics & Spine Hospital, is a 120-bed facility that provides medical and surgical care for orthopaedic and spine patients as well as general acute care for patients with nonsurgical needs. EUH is long known for cardiology, cardiac surgery, orthopaedics, oncology, and neurology/neurosurgery, and it has one of the most comprehensive transplant programs in the Southeast. In 2012, the University HealthSystem Consortium (UHC) ranked EUH 2 nd for quality out of over 100 academic medical centers. Among these UHC-ranked facilities, EUH has the highest case-mix index (a measure of complexity of illness treated). In 2012, U.S. News & World Report ranked EUH among the nation s best hospitals in five specialties. U.S. News & World Report also ranked EUH the top hospital in Metro Atlanta. EUH s community health needs assessment demonstrates the needs of our community. As a tertiary care facility, EUH serves patients from throughout the state of Georgia and the Southeast. For the purpose of EUH s community health needs assessment, EUH s community is defined as the contiguous area from which over 55% of EUH s inpatient admissions originate. EUH s community or primary service area includes DeKalb, Fulton, Gwinnett, Cobb, Henry, and Clayton counties. EUH Primary Service Area The EUH service area includes DeKalb, Fulton, Cobb, Gwinnet, Henry, and Clayton counties. July 2013 Page 4

7 PROCESS Emory University Hospital s (EUH) community health needs assessment was conducted by the Woodruff Health Sciences Center Strategic Planning Office. EUH s community health needs assessment was completed in conjunction with community health needs assessments for additional operating units and affiliates of Emory Healthcare (EHC) including: Emory University Hospital Midtown Emory Johns Creek Hospital Saint Joseph s Hospital Wesley Woods Geriatric Hospital Wesley Woods Long-term Acute Care Hospital Emory Adventist Hospital Southern Regional Medical Center A Steering Committee of representatives from across EHC and Emory University provided guidance and input during the development of the community health needs assessments. The Steering Committee members included the following individuals: Lynda Barrett, Director, Strategic Planning Community Health Needs Assessment Steering Committee Shari Capers, Associate Vice President, Strategic Planning Diane Cassels, Executive Administrator, Winship Cancer Institute at Emory University Amy Comeau, Assistant Director, Market Strategy & Support Vince Dollard, Associate Vice President, Communications Claudia Hall, Director, Marketing and Physician Recruitment, Southern Regional Medical Center Babs Hargett, Associate Administrator/Director, Quality Performance Improvement Keeli Johnson, Manager, Strategic Planning Dennis Kiley, CEO, Emory-Adventist Hospital Brandon Luten, Planning Associate, Strategic Planning Catherine Maloney, Associate Administrator, Emory University Hospital & Emory Orthopaedics & Spine Hospital Bev Miller, Director, Community Relations, Emory Johns Creek Hospital Karen O Donald, Director, Tax and Financial Performance Informatics Becky Provine, Chief Nursing Officer, Emory University Hospital Emily Pugh, EHC Administrative Fellow, Saint Joseph's Hospital Barbara Reed, EHC Patient Family Advisor Whitney Robinson, Manager, Strategic Planning Ellen Sacchi, Senior Director, Development, Emory Healthcare Karon Schindler, Executive Director, Health Sciences Publications Jen Schuck, Assistant Administrator, Wesley Woods Geriatric Hospital and Wesley Woods Long-Term Acute Care Hospital Peggy Seckler, Compliance Director, Emory-Adventist Hospital July 2013 Page 5

8 Community Health Needs Assessment Steering Committee Mindy Simon, Associate General Counsel, Emory University Sr. Rosemary Smith, Chief Mission Services Office, Saint Joseph's Hospital Betty Willis, Senior Associate Vice President, Government and Community Affairs, Emory University Toni Wimby, Associate Administrator, Emory University Hospital Midtown Linda Womack, Director, State Government Affairs, Emory University Additional valuable input and guidance was provided by the leadership of EHC, the leadership of each operating unit, and the leadership of the Boards. The community health needs assessments for EHC s operating units were completed over the course of 2012 and The community health needs assessment process was designed to assess the needs of the community served by each operating unit using quantitative data and input from stakeholders representing the broad interest of the community. The community health needs assessment took into account information from a variety of quantitative data sources including: The Atlanta Regional Commission Centers for Disease Control and Prevention (CDC) Centers for Disease Control and Prevention s Behavioral Risk Factor Surveillance System (BRFSS) Department of Health and Human Services Health Resources and Services Administration (HRSA) Department of Health and Human Services Healthy People 2020 Georgia Department of Public Health s Online Analytical Statistical Information System (OASIS) Georgia Hospital Association Truven Health Analytics United States Bureau of Labor Statistics United Health Foundation s America s Health Rankings University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation s County Health Rankings & Roadmaps Appendix A contains additional information on the data sources and highlights information gaps that impacted EUH s ability to assess the health needs of our community. Input from stakeholders representing the broad interest of the community was obtained through interviews. Interviews with seventeen organizations and one focus group were conducted with representatives from organizations with special knowledge of: The specific health needs of EHC patients, families, and employees Public health in the community served by each EHC operating unit The specific health needs of the community served by each EHC operating unit July 2013 Page 6

9 The health needs of underserved, low-income, and minority populations in the community served by each EHC operating unit The health needs of populations with chronic diseases in the community served by each EHC operating unit Appendix B contains a list of organizations that provided input during the community health needs assessment process. Using the qualitative data and input from community stakeholders, the health needs of the overall communities served by EHC were identified by the Steering Committee. The health needs were prioritized through a discussion among the Steering Committee. The EHC priority health needs were utilized by each operating unit to develop the priority needs for the community served by each operating unit. Implementation strategies were developed to outline how each EHC operating unit plans to address the identified health needs of the community it serves. The implementation strategies were developed by leadership at each operating unit with input from the Steering Committee. The community health need assessments and implementation strategies for each EHC operating unit were approved and adopted by the associated Boards and governing bodies. July 2013 Page 7

10 SERVICE AREA DEMOGRAPHICS As a tertiary care facility, EUH serves patients from throughout the state of Georgia and the Southeast. For the purpose of EUH s community health needs assessment, the community served by EUH, or the EUH primary service area (PSA), is defined as the contiguous area from which over 55% of EUH s inpatient admissions originate. EUH s PSA includes DeKalb, Fulton, Gwinnett, Cobb, Henry, and Clayton counties. EUH Primary Service Area Population The EUH service area includes DeKalb, Fulton, Cobb, Gwinnet, Henry, and Clayton counties. According to the Atlanta Regional Commission, between the years 2000 and 2010, Metro Atlanta s 28-county Metropolitan Statistical Area (MSA) was the third fastest growing area in the United States with the Atlanta population expanding by over 1 million new residents. Population Change for 100 Top Metros, Source: Atlanta Regional Commission, State of the Atlanta Region: 2011 July 2013 Page 8

11 In the past decade, the EUH PSA also experienced significant population growth. Between 2000 and 2012, the EUH PSA population increased by 625,137 people with an average annual growth rate of 1.6%. EUH PSA Population Year Population ,047, ,672, ,909,422 Source: Truven Market Expert Total Population Change, Source: Atlanta Regional Commission, State of the Atlanta Region: 2011 Over the next 5 years, the EUH PSA is expected to continue growing. Between 2012 and 2017, the population of the EUH PSA is anticipated to increase by 236,465 people with an annual average growth rate of 1.3%. The highest growth is anticipated along the northern and southern edges of the EUH PSA. Projected 5-Year Population Growth by ZIP Code EUH 5-Year Growth by ZIP Code < 0 0 to to 999 1,000 to 2,499 2,500 to 4,999 5,000 to 7,499 > 7,500 Source: Truven Market Expert July 2013 Page 9

12 Age Distribution The population of the EUH PSA is younger than the population of Georgia as a whole. In 2012, 10.3% of Georgia s population was over the age of 65 while 8.0% of the EUH PSA population was over the age of 65. Nearly one third of the EUH PSA population falls between the ages of Between 2012 and 2017, the most significant population increase in the EUH PSA is expected among persons in the and the 65+ age categories. Age Group PSA 2012 EUH PSA Age Distribution % of PSA Total % of Georgia Total PSA 2017 % of PSA Total , % 22.1% 879, % , % 4.4% 160, % , % 9.7% 354, % , % 14.1% 536, % ,128, % 28.8% 1,161, % , % 10.6% 438, % , % 10.3% 377, % Total 3,672, % 100.0% 3,909, % Source: Truven Market Expert Race Distribution EUH serves a racially and ethnically diverse service area. White non-hispanic residents and black non-hispanic residents each account for 40% of the EUH PSA population. Race/Ethnicity EUH PSA Race/Ethnicity Distribution 2012 Pop % of Total % of Georgia Total White Non-Hispanic 1,450, % 54.6% Black Non-Hispanic 1,418, % 30.4% Hispanic 473, % 9.4% Asian & Pacific Is. Non-Hispanic 244, % 3.5% All Others 87, % 2.1% Total 3,672, % 100.0% Source: Truven Market Expert Distribution of the Population By Race/Ethnicity, 2010 Source: Atlanta Regional Commission, State of the Atlanta Region: 2011 July 2013 Page 10

13 Gender Distribution The gender of the EUH PSA is evenly distributed between males and females. Within the EUH PSA, 824,653 females fall in the age range classified as child bearing age, ages Females of child bearing age represent 44.7% of the female population and 22.5% of the overall EUH PSA population. Gender EUH PSA Gender Distribution % of 2012 Pop Total % of Georgia Total Total Male Population 1,812, % 49.2% Total Female Population 1,860, % 50.8% Total 3,672, % 100.0% Source: Truven Market Expert Education Level Distribution The population of adults ages 25+ in the EUH PSA is more highly educated than the population of adults ages 25+ in the state of Georgia. In the state of Georgia, approximately 16% of the adult population does not hold a high school degree. In the EUH PSA, 12% of the adult population does not hold a high school degree. EUH PSA Education Level Distribution Adult Education Level Pop Age 25+ % of Total % of Georgia Total Less than High School 120, % 6.2% Some High School 152, % 10.2% High School Degree 538, % 29.1% Some College/Assoc. Degree 627, % 27.0% Bachelor's Degree or Greater 914, % 27.5% Total 2,353, % 100.0% Source: Truven Market Expert Household Income Distribution The EUH PSA is more affluent than the state of Georgia as a whole. Statewide, nearly 25% of households reported an annual household income of less than $25,000. In the EUH PSA, approximately 18% of households reported an annual income of less than $25,000. The median household income in the EUH PSA is $60,987, approximately 120% of the median income for Georgia of $50, Household Income EUH PSA Income Distribution Household % of Count Total % of Georgia Total <$15K 127, % 13.7% $15-25K 113, % 10.6% $25-50K 347, % 27.3% $50-75K 285, % 20.1% $75-100K 186, % 11.7% Over $100K 316, % 16.6% Total 1,378, % 100.0% Source: Truven Market Expert July 2013 Page 11

14 Labor Force Characteristics According to the Georgia Department of Labor, Georgia s seasonally adjusted unemployment rate in November 2012 fell to 8.5%, a decrease of 1.0% from November The November 2012 unemployment rate is the lowest reported unemployment rate for the state of Georgia since January In the EUH PSA, the unemployment rates for Clayton and Fulton counties exceed the Georgia average, while the unemployment rates for Cobb, DeKalb Gwinnett, and Henry counties fall below the Georgia average. EUH PSA Unemployment Rate, November 2012 Unemployment Area Rate Cobb County 7.3% Clayton County 10.2% DeKalb County 8.6% Fulton County 8.9% Gwinnett County 7.1% Henry County 8.5% Georgia 8.7% Source: U.S. Bureau of Labor Statistics Insurance Coverage Insurance coverage in the EUH PSA is more prevalent than in the state of Georgia as a whole. In 2012, approximately 14.0% of the EUH PSA population was uninsured while approximately 19.0% of the total population in the state of Georgia was uninsured. In the EUH PSA, the uninsured population varies significantly by ZIP code. The uninsured population in EUH s home ZIP code falls in the 500 to 999 range while the uninsured population in other select ZIP codes within the EUH PSA fall in the greater than 15,000 range. EUH PSA Insurance Coverage % of Coverage Type 2012 Pop Total % of Georgia Total Managed Care 2,165, % 55.7% Medicare 259, % 9.5% Medicaid 428, % 13.3% Medicare Dual Eligible 51, % 2.5% Uninsured 515, % 19.0% Total 3,672, % 100.0% Source: Truven Market Expert 2012 Uninsured Population by ZIP Code EUH Uninsured Population by ZIP Code < to 999 1,000 to 2,499 2,500 to 4,999 5,000 to 9,999 10,000 to 14,999 > 15,000 Source: Truven Market Expert July 2013 Page 12

15 GENERAL HEALTH RANKINGS Georgia s Health Rank On an annual basis, the United Health Foundation releases America s Health Rankings, a report that provides an overview of the nation s health and the health of each individual state. America s Health Rankings provides a basis for comparing the health of the states in the nation by ranking states from 1 to 50. The rankings are provided for a variety of measures of health. The lower the ranking, the better the health of a state on a specific metric. The higher the ranking, the worse the health of a state on a specific metric. If a state is ranked 1 st on a metric the population of that state is the healthiest state population in the nation. If a state is ranked 50 th on a metric the population of that state is the least healthy state population in the nation. In 2012, Georgia ranked 36 th out of the 50 states on the overall health rank. Over the past 22 years, Georgia has consistently ranked in the high 30s and low 40s for overall health status. A state s overall rank is determined based on a combination of a determinants rank and an outcomes rank. The determinants rank takes into account actions a state can take to affect the health of its population in the future in areas including behaviors, community and environment, public health, clinical care, and so forth. The outcomes rank takes into account conditions that have occurred in a population including death, disease, and effects of an illness. In 2012, Georgia ranked 37 th in the determinants rank and 39 th in the outcomes rank. According to the United Health Foundation, to improve the health of its population and overall rank, a state must focus its efforts on impacting the determinants of health. County Health Rankings Georgia s Overall Health Rank ( ) Source: United Health Foundation s America s Health Rankings Georgia s Health Rankings 2006 Rank 2012 Rank Determinants Outcomes Overall Source: United Health Foundation s America s Health Rankings On an annual basis, the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation releases County Health Rankings & Roadmaps, a report that provides an overview of the health of each individual state and each county within a state. The report ranks the health of each county in a state in comparison to the health of the other counties in July 2013 Page 13

16 the state. Since Georgia has 159 counties, County Health Rankings ranks the counties in Georgia on a scale of 1 to 159. The lower the ranking, the better the health of a county. The higher the ranking, the worse the health of a county. County Health Rankings includes two primary rankings a health outcomes rank and a health status rank. The rankings are determined based on county-level data from a variety of national and state data sources. Health Outcomes Rank The Health Outcomes Rank is based on mortality and morbidity factors measuring both the length of life of the population in the county and the quality of life of the population in the county. A lower ranking indicates better health outcomes in a county. In 2012, the EUH PSA counties were ranked the following in comparison to other Georgia counties on health outcomes: Clayton County 46 Cobb County 6 DeKalb County 18 Fulton County 26 Gwinnett County 5 Henry County 17 Source: County Health Rankings & Roadmaps Health Factors Rank The Health Factors Rank is based on four types of factors health behaviors, clinical care, social/economic, and physical environment. A lower ranking indicates better health factors in a county. In 2012, the EUH PSA counties were ranked the following in comparison to other Georgia counties on health outcomes: Clayton County 120 Cobb County 7 DeKalb County 22 Fulton County 20 Gwinnett County 8 Henry County 12 Source: County Health Rankings & Roadmaps July 2013 Page 14

17 MORTALITY Mortality measures provide a basis for understanding the causes of death in a population. The Georgia Department of Public Health s health data repository, the Online Analytical Statistical Information System (OASIS), provides data and insight into the various mortality statistics in the EUH PSA counties. In numerous sections, the outcomes for the EUH PSA counties are compared to the Atlanta 28-county Metropolitan Statistical Area (MSA-28) and the state of Georgia. In some instances, data for 2009 is not available. The most recent available data is for While information is available based on race and ethnicity, information is not available based on income. Age-Adjusted Death Rate Mortality refers to the level of death in a population. Age-adjusted reflects a weighted average of the age-specific mortality rates. By controlling for differences in age structure, observed differences in rates across areas are not due solely to differences in the proportion of people in different age groups in different areas. The age-adjusted death rate expresses deaths as a rate per 100,000 population. In 2010, the age-adjusted death rate in the EUH PSA (744 per 100,000) fell below the age-adjusted death rate of the Atlanta MSA (785 per 100,000) and Georgia (829 per 100,000). Over the past 5 years, the age-adjusted death rate in the EUH PSA has dropped significantly from 792 to 744 per 100,000 population Age-Adjusted Death Rate per 100,000 Population EUH PSA Counties Atlanta MSA-28 Georgia Source: OASIS The age-adjusted death rate per 100,000 population for black residents of the EUH PSA exceeds the age-adjusted death rate of the EUH PSA as a whole. However, this rate has dropped significantly from 980 to 860 per 100,000 population over the 5 year 1, Age-Adjusted Death Rate per 100,000 by Race/Ethnicity, EUH PSA EUH PSA Counties White Non-Hispanic, EUH PSA Black, EUH PSA Hispanic, EUH PSA Other, EUH PSA Source: OASIS period. Asian, American Indian/Alaska Native, Native Hawaiian/Pacific Islander, Multiracial, and unknown residents of the EUH are categorized as other. The age-adjusted death rate July 2013 Page 15

18 per 100,000 population for Hispanic and other residents of the EUH PSA falls significantly below the age-adjusted death rate per 100,000 population of the EUH PSA as a whole. However, the rate for other residents has increased significantly from 144 to 404 per 100,000 population over the 5 year period. Fetal Mortality Rate The fetal mortality rate represents the number of fetal deaths (at or greater than 20 weeks gestation) per 1,000 fetal deaths (at or greater than 20 weeks gestation) plus live births. Between , the fetal mortality rate in the EUH PSA on average fell above the fetal mortality rate for Atlanta and Georgia. In 2010, the Fetal Mortality Rate per 1,000 Fetal Deaths/Live Births EUH PSA Counties Atlanta MSA-28 Georgia Source: OASIS fetal mortality rate for black residents of the EUH PSA exceeded the fetal mortality rate for the EUH PSA as a whole. Fetal Mortality Rate per 1,000 Fetal Deaths/Live Births EUH PSA Counties Atlanta MSA-28 Georgia White Non- Hispanic, EUH PSA Black, EUH PSA Hispanic, EUH PSA Other, EUH PSA Source: OASIS Age-Adjusted Death Rate by Cause The World Health Organization defines the underlying cause of death as the disease or injury that initiated the sequence of events leading directly to death or as the circumstances of the accident or violence that produced a fatal injury. The World Health Organization has defined a list of sixteen cause of death categories. Appendix C contains a list of the cause of death categories and associated conditions. In the EUH PSA, major cardiovascular disease and cancer had the highest reported ageadjusted death rates per 100,000 population in Major cardiovascular diseases and cancer July 2013 Page 16

19 also had the highest reported death rates per 100,000 population in Atlanta and Georgia. While the death rates in the EUH PSA for major cardiovascular diseases and cancer fall below the reported death rates in Atlanta and Georgia, the death rates are significantly higher than other categories of diseases. In America s Health Rankings 2012, Georgia ranked 37 th for cardiovascular deaths per 100,000 and 19 th for cancer deaths per 100,000. In the EUH PSA, the age-adjusted death rates for the majority of causes of death are lower than the associated age-adjusted death rates in Atlanta and Georgia. However, the EUH PSA age-adjusted death rates for mental and behavioral disorders, bone and muscle diseases, birth defects, infectious diseases, blood diseases, and pregnancy and childbirthing complications were higher than either the Atlanta MSA or Georgia age-adjusted death rates for these causes of death. Cause of Death Age-Adjusted Death Rate per 100,000 Population, 2010 EUH PSA Counties Atlanta MSA-28 Georgia Major Cardiovascular Diseases Cancer Respiratory Diseases External Causes Mental and Behavioral Disorders Nervous System Diseases Endocrine, Nutritional and Metabolic Diseases Infectious Disease Digestive System Diseases Reproductive and Urinary System Diseases Fetal and Infant Conditions Bone and Muscle Diseases Birth Defects Blood Diseases SIDS Pregnancy and Childbirthing Complications Note: The EUH PSA death rates that exceed the death rates in Atlanta and Georgia are highlighted in gray Source: OASIS July 2013 Page 17

20 MORBIDITY Morbidity measures provide a basis for understanding people s quality of life or how healthy people feel while they are alive. Quality of life includes a person s overall health, physical health, and mental health. County Health Rankings & Roadmaps provides information on a number of morbidity measures at a county level using data from the Centers for Disease Control and Prevention s Behavioral Risk Factor Surveillance System (BRFSS). BRFSS data is designed to be representative of the non-institutionalized population ages 18+ in the United States residing in households with a land-line telephone. County Health Rankings & Roadmaps data is not available based on race, ethnicity, or income. Poor or Fair Health County Health Rankings & Roadmaps uses the BRFSS survey question, In general, would you say that your health is excellent, very good, good, fair, or poor? to gauge the overall self-reported health in a county. County Health Rankings & Roadmaps reports the percentage of adults selfreporting their health status as fair or poor. In the County Health Rankings & Roadmaps 2012, the percentage of self-reported fair or poor health status in Clayton County exceeded the average for Georgia. The percentage of self-reported fair or poor health status in the other EUH PSA counties fell below the average for Georgia. Percentage of Adults Reporting Poor or Fair Health Clayton County 17% Cobb County 11% DeKalb County 13% Fulton County 13% Gwinnett County 12% Henry County 13% Georgia 16% Source: County Health Rankings & Roadmaps Poor Physical Health Days County Health Rankings & Roadmaps uses the BRFSS survey question, Thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? to gauge the overall self-reported poor health days in a county. County Health Rankings & Roadmaps reports the number of days adults self-reported their health status as not good. In the County Health Rankings & Roadmaps 2012, the self-reported number of days of not good health in the last 30 days in Clayton County is equal to the average for Poor Physical Health Days Clayton County 3.6 Cobb County 3.0 DeKalb County 2.5 Fulton County 2.9 Gwinnett County 3.0 Henry County 3.2 Georgia 3.6 Source: County Health Rankings & Roadmaps Georgia. The self-reported number of days of not good health in the last 30 days in the other EUH PSA counties fell below the average for Georgia. In America s Health Rankings 2012, July 2013 Page 18

21 Georgia was ranked 19 th out of 50 states for the number of poor physical health days reported in the previous 30 days. Poor Mental Health Days County Health Rankings & Roadmaps uses the BRFSS survey question, Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? to gauge the overall self-reported poor mental health days in a county. County Health Rankings & Roadmaps reports the number of days adults self-reported their mental health status as not good. In the County Health Rankings & Roadmaps 2012, the self-reported number of days of not good health in the last 30 days in Clayton Poor Mental Health Days Clayton County 3.8 Cobb County 2.9 DeKalb County 3.0 Fulton County 2.9 Gwinnett County 2.8 Henry County 2.9 Georgia 3.4 Source: County Health Rankings & Roadmaps County exceeded the average for Georgia. The self-reported number of days of not good health in the last 30 days in the other EUH PSA counties fell below the average for Georgia. In the America s Health Rankings 2012, Georgia was ranked 28 th out of 50 states for the number of poor mental health days reported in the previous 30 days. July 2013 Page 19

22 GENERAL HEALTH MEASURES To provide a deeper understanding of the health of the population in the EUH PSA, additional data from the Centers for Disease Control and Prevention s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) survey and America s Health Ranking is provided for a number of the leading causes of deaths in the EUH PSA and other conditions that negatively impact the health of a population including obesity, smoking and tobacco use, cardiovascular/heart disease, cancer, respiratory diseases, diabetes, and mental health. The CDC s BRFSS survey asks a number of questions designed to gauge the prevalence of various health behaviors and conditions among survey respondents. BRFSS data is designed to be representative of the non-institutionalized population ages 18+ in the United States residing in households with a land-line telephone. While information is available based on income for specific topics, information is not available based on race and ethnicity. America s Health Rankings provides a basis for comparing the health of the states in the nation by ranking the states from 1 to 50. The rankings are provided for a variety of measures of health. The lower the ranking, the better the health of a state on a specific metric. The higher the ranking, the worse the health of a state on a specific metric. America s Health Rankings data is not available based on race, ethnicity, or income. Where applicable, focus areas and specific goals of Healthy People 2020 are highlighted. Healthy People is a Department of Health and Human Services program designed to guide health promotion and disease prevention across the United States. Every decade since 1979, Healthy People has established 10 year goals and targets for the nation. In 2010, Healthy People 2020 was released. Healthy People 2020 includes over 1,200 objectives in over 40 topic areas to guide efforts to improve the health of the nation by July 2013 Page 20

23 Obesity Obesity is a major health issue across the United States. Nearly one out of every three adults is considered obese. Obesity negatively impacts one s health and contributes to a variety of conditions including heart disease, stroke, Type 2 diabetes, hypertension, cancer, respiratory problems, and so forth. Since 1990, obesity has increased steadily in the United States and in Georgia. In America s Health Rankings 2012, Georgia ranked 27 th out of 50 states for the percentage of obese adults in the population. Obesity prevalence is the percentage of the adult population estimated to be obese. The prevalence of obesity is typically determined using multiple years of the data from the Centers for Disease Control and Prevention s Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS survey asks respondents to provide their height and weight and uses the information to classify the individual into one of four body mass index (BMI) categories underweight, normal weight, overweight, and obese. Individuals with a body mass index of 30.0 or higher are considered obese. In 2012, the BRFSS classified approximately 2 million adults in Georgia, 26.4% of the population, as obese. In the EUH PSA, 25.1% of the adult population was considered obese. Obesity information based on median household income is not available. Area Obesity Prevalence Raw # Obese % Obese in 2012 Area Population EUH PSA 671, % Atlanta MSA , % Georgia 1,929, % United States 60,390, % Note: Obesity information is not available based on median household income Source: Truven Market Expert BRFSS Data Nutrition and Weight Status is a focus area in Healthy People A goal of Healthy People 2020 is to Promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights. Healthy People 2020 has identified twenty-two objectives to support its goal. According to Healthy People 2020, between 2005 and 2008, 33.9% of persons over the age of 20 were obese. One objective of Healthy People 2020 s Nutrition and Weight Status goal is to reduce the proportion of adults who are obese to 30.5% nationwide by the year Smoking & Tobacco Use According to Healthy People 2020, smoking is the leading cause of preventable death in the United States. Tobacco use in the United States is estimated to be responsible for approximately 1 in 5 deaths or approximately 443,000 deaths per year. Tobacco use causes a July 2013 Page 21

24 number of diseases including respiratory disease, heart disease, stroke, and cancer. According to America s Health Rankings 2012, 21% of adults in American smoke regularly. According to America s Health Rankings 2012, Georgia ranked 25 th out of 50 states for the percentage of the adult population who smokes regularly with 21.2% of adult Georgians smoking regularly. County Health Rankings 2012 provides insight into the percentage of the adult population that smokes regularly in each county in Georgia. In 2012, the percentage of adults reporting smoking regularly in the EUH PSA were as follows: Clayton County 21% Cobb County 15% DeKalb County 12% Fulton County 15% Gwinnett County 15% Henry County 20% Tobacco Use is a topic area in Healthy People A goal of Healthy People 2020 is to Reduce illness, disability, and death related to tobacco use and secondhand smoke exposure. Healthy People 2020 has identified twenty objectives to support its goal organized into the three key areas: Tobacco Use Prevalence: Implementing policies to reduce tobacco use and initiation among youth and adults Health System Changes: Adopting policies and strategies to increase access, affordability, and use of smoking cessation services and treatments Social and Environmental Changes: Establishing policies to reduce exposure to secondhand smoke, increase the cost of tobacco, restrict tobacco advertising, and reduce illegal sales to minors Cardiovascular/Heart Disease Cardiovascular disease or heart disease describes the diseases affecting the heart. Cardiovascular disease is the main contributor to heart attacks, chest pain, and stroke. According to the CDC, heart disease was the leading cause of death in the United States in 2011 accounting for 599,413 deaths. Stroke was the 4 th leading cause of death accounting for 128,842 deaths in According to America s Health Rankings 2012, Georgia ranked 37 th out of 50 states for cardiovascular deaths. Georgia ranked 25 th for heart attacks and 38 th for stroke. High blood pressure, high cholesterol, and smoking are the main risk factors for heart disease and stroke. According to the CDC, nearly 50% of Americans have at least one of the three main risk factors for heart disease and stroke. Additional risk factors for heart disease and stroke include diabetes, obesity, lack of physical activity, poor diet, and excessive alcohol use. July 2013 Page 22

25 The BRFSS survey gauges the prevalence of a number of the risk factors for heart disease and stroke by asking survey respondents if they are personally afflicted with or being treated for a variety of conditions, including heart disease, high blood pressure, and high cholesterol. In America s Health Rankings 2012, Georgia ranked 33 rd out of the 50 states for heart disease. In 2012, Area Heart Disease Prevalence Raw # Heart Disease EUH PSA 173, % over 575,000 adults in Georgia, Atlanta MSA , % 8.0% of the population, reported Georgia 582, % having heart disease. In the EUH United States 19,555, % PSA, heart disease is less prevalent Source: Truven Market Expert BRFSS Data than in Georgia. In the EUH PSA, heart disease is more prevalent Heart Disease Prevalence Among Low Income Population Raw # among low income adults with a median household income below Area (Includes Households with a Median Income <$25,000 Only) Heart Disease EUH PSA 42, % $25,000 than the EUH PSA Atlanta MSA-28 67, % population as a whole. However, Georgia 188, % heart disease is less prevalent United States 5,923, % among the low income adult Source: Truven Market Expert BRFSS Data population in the EUH PSA than the low income adult populations in Atlanta and Georgia. According to America s Health Rankings 2012, Georgia ranked 33 rd out of 50 states for high blood pressure prevalence. In 2012, over 1.85 million adults in Georgia, 25% of the population, reported having high blood pressure. In the EUH PSA, high blood pressure is less prevalent than in Georgia. In the EUH PSA, high blood pressure is more prevalent among adults with a median household income below $25,000 than the EUH PSA population as a whole. However, high blood pressure is less prevalent among Area High Blood Pressure Prevalence Raw # High Blood Pressure % Heart Disease in 2012 Area Population % Heart Disease in 2012 Area Population % High Blood Pressure in 2012 Area Population EUH PSA 612, % Atlanta MSA , % Georgia 1,850, % United States 61,775, % Source: Truven Market Expert BRFSS Data High Blood Pressure Prevalence Among Low Income Population Area (Includes Households with a Median Income <$25,000 Only) Raw # High Blood Pressure % High Blood Pressure in 2012 Area Population EUH PSA 124, % Atlanta MSA , % Georgia 512, % United States 16,421, % Source: Truven Market Expert BRFSS Data the low income adult population in the EUH PSA than the low income adult populations in Georgia. July 2013 Page 23

26 According to America s Health Rankings 2012, Georgia ranked 18 th out of 50 states for high cholesterol prevalence. In 2012, over 1.5 million adults in Georgia, 21% of the population, reported having high cholesterol. In the EUH PSA, the prevalence of high cholesterol is similar to the prevalence in Atlanta and Georgia. In the EUH PSA, high cholesterol is more prevalent among adults with a median household income below $25,000 than the EUH PSA population as a whole. However, among the low income population the EUH PSA, the prevalence of high cholesterol is similar to the prevalence among the low income populations in both Atlanta and Georgia. Heart Disease and Stroke is a topic area in Healthy People A goal of Healthy People 2020 is to Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart disease and stroke; early identification, and treatment of heart attacks and stroke; and prevention of repeat cardiovascular events. Healthy People 2020 has identified twenty-four objectives to support its goal. According to Healthy People 2020, in 2007, coronary heart disease deaths per 100,000 population and 42.2 stroke deaths per 100,000 population occurred in the United States. An objective of Healthy People 2020 is to decrease the coronary heart disease death rate to deaths per 100,000 population and the stroke death rate to 33.8 per 100,000 population by the year Cancer Area High Cholesterol Prevalence Raw # High Cholesterol % High Cholesterol in 2012 Area Population EUH PSA 557, % Atlanta MSA , % Georgia 1,529, % United States 52,381, % Source: Truven Market Expert BRFSS Data High Cholesterol Prevalence Among Low Income Population Area (Includes Households with a Median Income <$25,000 Only) Raw # High Cholesterol % High Cholesterol in 2012 Area Population EUH PSA 105, % Atlanta MSA , % Georgia 401, % United States 13,244, % Source: Truven Market Expert BRFSS Data Cancer is the term used to describe diseases that involve abnormal cells dividing without control and invading other tissues in the body. Over 100 different types of cancer exist. The National Cancer Institute (NCI) estimates 40% of men and women in the United States will be diagnosed with cancer at some point during their lifetime. According to the CDC, cancer was the 2 nd leading cause of death in the United States in 2011, accounting for 567,628 deaths. In 2012, NCI estimates over 575,000 cancer related deaths will occur and over 1.6 million new cases of cancer will be diagnosed. In recent years, the both the incidence and death rates for July 2013 Page 24

27 cancer have declined. According to America s Health Rankings 2012, Georgia ranked 19 th out of 50 states for cancer deaths. The main risk factors for a number of cancers are lack of physical activity, poor nutrition, obesity, use of tobacco products, and ultraviolet light exposure. Reducing these risk factors may prevent a number of types of cancer. Cancer screenings are an effective way to identify certain types of cancer early on in the disease progression including colorectal cancer, cervical cancer, and breast cancer. The BRFSS survey asks questions designed to gauge the prevalence of a cancer screenings for colorectal cancer, cervical cancer, and breast cancer. The BRFSS survey asks respondents, Over the past 2 years have you or anyone else in Area your household received a colorectal cancer screening test when there were no prior symptoms? In 2012, over 875,000 households in Georgia, 24.0% of the households, reported having a colorectal screening within the last 2 years. The percentage of households reporting having a routine colorectal cancer screening every 2 years in the EUH PSA population as a whole and the low income EUH PSA population are both similar to the respective percentages in both the Atlanta area and Georgia. Colorectal Cancer Screening Within Past 2 Years Raw # Households Screened % Screened in 2012 Area Households EUH PSA 335, % Atlanta MSA , % Georgia 882, % United States 29,840, % Source: Truven Market Expert BRFSS Data Colorectal Cancer Screening Within Past 2 Years Among Low Income Population Area (Includes Households with a Median Income <$25,000 Only) Raw # Households Screened % Screened in 2012 Area Households EUH PSA 57, % Atlanta MSA-28 86, % Georgia 211, % United States 6,894, % Source: Truven Market Expert BRFSS Data The BRFSS survey asks females over the age of 18, Over the Cervical Cancer Screening Within the Past 2 Years Raw # Female past 2 years have you had a Population cervical cancer screening/pap Area 18+ Screened smear when there were no prior symptoms? In 2012, over 2.25 million females over the age of EUH PSA Atlanta MSA-28 Georgia 886,334 1,282,487 2,255, % 63.3% 60.0% 18 in Georgia, 60.0% of the United States 73,056, % Source: Truven Market Expert BRFSS Data females over the age of 18, reported having a cervical cancer screening/pap smear within the last 2 years. The percentage % Screened in 2012 Area Female Population 18+ July 2013 Page 25